Editing Vocal cord nodule (section)

=== Behavioural treatment ===
Behavioural [[voice therapy]] is typically carried out by [[speech-language pathology|speech–language pathologist]]s.<ref>{{cite journal|last1=Fisher|first1=Kimberly V.|year=1996|title=Vocal fold nodules|journal=Current Opinion in Otolaryngology & Head and Neck Surgery|volume=4|issue=3|pages=166–71|doi=10.1097/00020840-199606000-00002|s2cid=72194214}}</ref> While behavioural treatments methods vary greatly, they are generally effective at improving vocal quality and decreasing size of vocal fold nodules.<ref name=":0" /><ref name="pmid19741535" /> Complete resolution of nodules through behavioural treatment is possible<ref name=":0" /> but unlikely.<ref name="pmid19741535" />

Behavioural techniques can be indirect or direct.<ref name=":0" /> Indirect approaches focus on improving vocal hygiene, introducing and/or maintaining safe voice practices (thereby reducing opportunities for phonotrauma) and, occasionally, implementing [[vocal rest]].<ref name="pmid19779347" /> Direct approaches involve reducing the physiological strain on the vocal system while the voice is being used (e.g. during speaking or singing), such as by reducing collision forces between the vocal folds, ensuring sufficient [[Lung|pulmonary support]] while speaking (e.g. by changing the individual's breathing pattern), and optimizing [[resonance]] of the [[larynx]] and other structures of the [[Place of articulation|vocal apparatus]].<ref name="pmid19741535" />

Behavioural treatments also vary in delivery model.<ref name=":0" /> Traditional therapy distribution (e.g. eight sessions within eight weeks), more intensive approaches (e.g. eight session within three weeks) and remote therapy (i.e. [[telehealth]]) have all shown effectiveness in treating vocal fold nodules.<ref name=":0" />

Assessment of outcomes of behavioural treatments also varies greatly.<ref name=":0" /> Effects can be measured visually<ref name=":0" /> (e.g. by the same methods typically used to confirm the presence of vocal fold nodules: video [[endoscopy]] and video [[Stroboscope|stroboscopy]]<ref name=":0" />), aerodynamically<ref name=":0" /> (e.g. by measuring parameters such as transglottal pressure and the glottal airflow waveform<ref>{{Cite journal|last1=Holmberg|first1=Eva B.|last2=Doyle|first2=Patricia|last3=Perkell|first3=Joseph S.|last4=Hammarberg|first4=Britta|last5=Hillman|first5=Robert E.|date=2003|title=Aerodynamic and acoustic voice measurements of patients with vocal nodules: variation in baseline and changes across voice therapy|journal=Journal of Voice|volume=17|issue=3|pages=269–282|doi=10.1067/s0892-1997(03)00076-6|pmid=14513951|issn=0892-1997}}</ref>), perceptually<ref name=":0" /> (e.g. by rating the voice in terms of dimensions such as roughness, breathiness, asthenia and strain<ref name=":0" />), in terms of effect on quality of life measures,<ref name=":0" /> or using any combination of the above.<ref name=":0" />

Finally, recurrence of vocal fold nodules after behavioural treatment is always a possibility, particularly if nodules were not completely resolved or if skills gained during treatment were not carried-over outside of therapy sessions or maintained after therapy blocks.<ref name=":0" />